I-PSA isilingo, kunye ne-cholesterol kunye nezinye iimvavanyo, yinto eqhelekileyo yokuhlolwa kwegazi eyenzeka ngexesha lokuhlolwa komzimba konyaka. Kodwa kufuneka uyenze ntoni ukuba i-PSA ingaphandle kwebala eliqhelekileyo kwingxelo yebhu lab yakho? Ukuba uhlolisisa ikopi yebhanki ebhaliweyo ebhaliweyo, ukuchaza iimvavanyo zakho, unokufumana iinkcukacha ezichazayo (jonga ngezantsi) ezifumaneka rhoqo kwingxelo:
I-PSA yesilingo akufanele iguqulelwe njengobungqina obungqina bokuba ubukho okanye ukungabikho kwesifo esibi kwaye akumele kusetyenziswe yedwa njengomvavanyo wokuhlola umhlaza. Ulungelelwano lwezonyango luyadingeka.
Ukuxinwa kwe-PSA ephakamileyo kunokubonisa nje ukuba ubukho bomhlaza wesibeletho kwaze kwaba yilapho i-biopsy isenziwa. I-concentration ye-PSA ingaphakanyiswa kwakhona kwi-benign prostatic hyperplasia okanye kwiimeko ezivuthayo ze-prostate. I-PSA ayinakuphakanyiswa kwindoda enempilo okanye amadoda angenazo i-prostatic carcinoma. "
I-Verbiage yalolu hlobo ichaza ukuba isinyathelo esilandelayo siya kuba yi-biopsy. Enyanisweni, kubonisa ukuba i-biopsy isisigqibo esiphezulu. I-needle biopsy yeprostate ukuvavanya amadoda anePSA ephakamileyo ibe yindlela yokugcina yegolide iminyaka engama-30. Kuze kube kutshanje, ukuthatha iisampuli ezininzi zeprotate ukuze kuhlolwe i-microscopic yindlela yokuphela komdlavuza wesibeletho.
Inkqubo yokuLungisa iNyululwazi
Inkqubo ye - biopsy ye- needle ye-12 engundoqo yenzalo ihlelwe kakuhle kwinkqubo enokusebenza kwaye ingaqhutyelwa yi-urologist eofisini yakhe.
Le ndoda igxile kwicala layo imilenze yakhe isondele esifubeni sayo. I-Novocain ifakwe kwi-prostate kunye neye-12, ezinkulu-zizalise iiliti ze-needle zikhishwe ngompu we-biopsy ephethe intwasahlobo. I-antibiotics ilawulwa rhoqo ukukhusela usulelo.
Ukuba kwenziwe ngobugcisa, inkqubo ye-biopsy ithatha imizuzu eyi-10 ukuya kwe-20.
Emva kwenkqubo, amadoda ahlala ephaphaza emcini kunye neenja kwiiveki ezimbalwa. Iingxaki zesikhashana kunye nokulungiswa kwazo ziya kwenzeka. Naphezu kwee-antibiotics, inani elincinci lamadoda (malunga neepesenti ezi-2) liza kuhlakulela izifo ezinzulu ngokwaneleyo zokubhedlelelwa esibhedlele. Iibhentshi ezisuswe kwi-prostate zihanjiswa ziza kuhlaziywa ngugqirha ogqirha obizwa ngokuba ngu-pathologist. Iziphumo zifumaneka rhoqo kwiintsuku ezimbini ukuya kwethathu.
Ukutolika ingxelo yePathology
Ugqirha ohlola i- specimen ye-biopsy , isifo sezilwanyana, ubika ubungqina okanye ukungabikho komhlaza kwi-cores kususwe kwi-gland. Xa umdlavuza ukhona, ugqirha wezilwanyana uphinda uxela inani lomhlaza (inani leengqamana ezinomdlavuza) kunye nebakala lomdlavuza. Ibanga lomhlaza lenye yezona zinto zidibanisa kakhulu umdlavuza wesibeletho.
Emuva kuma-1960, udokotela wezifo ezidumileyo, uDkt. Donald Gleason, wathi ingxelo yokuziphatha komhlaza wesifo se-prostate ingaxelwa ngamaphethini eselula abonwa phantsi kwe-microscope. Wakhela inkqubo yokubamba ukusuka ku-2 kuya kwe-10 eyabikezela ukuba kuya kuba njani umhlaza ukusasazeka (imastastate). Icandelo le-Gleason yakhe yokulinganisa isistim isoloko isetyenziswa nanamhla. Ezinye iinkalo zenkqubo ziye zaguquka ngokuhamba kwexesha.
Utshintsho olukhulu luye lwafumanisa ukuba ama-Gleason amanqaku angama-6 okanye ngaphantsi awona ahlaleneyo. Ngethuba le "iiseli ezingaqhelekanga" zinokubonakala kwezinye zomhlaza, izifundo zenzululwazi ziye zagqiba ukuba iGleason 6 okanye ngaphantsi ayifumananga. Iiseli ezingavumelekanga ezingabonakaliyo kufuneka zihlelwe njengezifo ezihlambulukileyo, kungekhona umhlaza.
Icandelo lezoNyango kwiShintsho
Ngelishwa, utshintsho lwenzeka kancane kwihlabathi lonyango. Xa wena okanye othandekayo ufumana ikopi yengxelo yesifo esisemthethweni kwaye ubone igama elithi adenocarcinoma, mhlawumbi uya kufumana le nto ibe yinto ephazamisayo. Phantse amadoda angama-miliyoni angama-biopsy minyaka yonke.
Kula madoda anesigidi, abancinci abangaphezu kwe-100 000 kubo baya kufumana i- Gleason 6 (okanye ngaphantsi) i-adenocarcinoma.
Icandelo lomdlavuza we-prostate ekugqibeleni liqala ukulungelelanisa ekuqinisekiseni ukuba i-cancer yebanga lesi-6 ayinomhlaza. Nangona kunjalo, ngo-2015, kuphela malunga nesiqingatha samadoda afumaneka kwiBakala 6 (amadoda angama-50,000) abekwe esweni sokujonga iliso kunokuba enze utyando olusisiseko okanye imitha. Inyaniso yokuba ama-50% wamadoda aqhubeka esichengisa unyango, ukubeka ingozi yokuziphatha ngokwesini kunye nokulahlekelwa kolawulo lwe-urinary (ukunganyani) kwimeko engabonakaliyo, kubonisa ngokucacileyo ukuba icandelo lezonyango lifuna ukuphucula. Ulwaphulo olunjalo olunobundlobongela lunokuthi lufaneleke njani ngokubhekiselele kwinto esiyaziyo ngokubhekisele kumdlavuza wesibeletho?
I-Cancer yiLizwi le-ezine
Oogqirha baqala ukuguqula iingqondo zabo, kodwa kuthatha ixesha ukutshintsha. Ingxenye yengxaki kukuba umhlaza ngumagama oonobumba abane. Iilebula zinamandla, nangona zingenamanga. Ngokomzekelo, igama elithi ubuhlanga linikeza ukufana okulungileyo. Igama elithi "ngokobuhlanga," nokuba ingaba lixesha lilungeleleneyo, linamathela njengeglue. Xa abantu baninzi bazivikela, i-guiltier iyavela.
Enye into enamandla yokuguqula inguqu kukuba i-industry enkulu ye-prostate-dollar prostate ishishini lakhiwe kwiminyaka engama-40 edluleyo. Kunzima ukuba i-urologists iguqule iindlela zazo kwaye igweme ukwenza ukuhlinzwa. Ukuchitha ixesha kwigumbi lokusebenza liyinxalenye yesazisi yabo. Kwaye ngokuqinisekileyo, de kube yiminyaka eyi-10 edlulileyo, kwakungekho nezinye iindlela. Unyango olunokunyamekela lunokuthi lulungele ixesha elifanelekileyo xa wonke umntu ekholelwa ukuba yonke umdlavuza weprotate yayisongela ubomi. Udweliso olunzulu lwaluyimfuneko yendalo yonke.
Ukungaqiniseki kokuGada
Esinye isizathu sokuba amadoda anomdlavuza ongaphantsi-phantsi aqhubeke unyango olungadingekile kunye nokuhlinzwa kukuba izigulane kunye noogqirha ngokufanayo bayaziva ukuba kuyindlela ehlakaniphile. Izifundo zibonisa ukuba i-biopsy ye-12 engundoqo ayiphumeli ukufumana umhlaza wesikolo esiphakeme (ibakala lesi-7 ukuya kwe-10) i-25 ekhulwini yexesha! Khumbula, ii-cores zifakwe kwi-prostate ngokungenasiphelo , ngaphandle kolwazi lwesimo se-tumor. Ukuqwalasela oku kungacaciswanga, kukho ukwesaba okufanelekileyo ukuba umhlaza wesigaba esiphakeme ungasalindela ukungafunyanwa kwi-prostate. Ngamanye amaxesha amadoda akhetha ukunyango "Ukuze ukhuseleke."
Abo bakhetha ukongamela ngentshukumo mhlawumbi banesifo seprotate yabo yonke imizuzu emibini. Basenokungazi, ukuba oogqirha bazama ukuhlawulela ukungalungi kwe-biopsy engahleliyo ngokuphindaphinda ngokuphindaphindiweyo. Ngoxa le nto ingonwabi kwaye ingekho ingozi, uphando lwexesha elide lubonisa ukuba le ndlela ikhuselekile ngokufanelekileyo. Ininzi yamadoda aphethe izifo eziphezulu eziphezulu ephosakeleyo kwi-biopsy yokuqala efunyenwe yi-biopsy elandelayo xa umhlaza usesikhatyweni esaneleyo ukwenzela ukuba uphulukiswe.
Ukucinga, Ukujoliswe Kukho Kunokuba I-Biopsy Yengqonge
Esikhundleni sokuhamba kwinkqubo yokungahlambulukiyo ye-biopsy, izigulana zinokuya kwiziko le-excellence ukwenzela ukukhangela iprotate nge-MRI eyahlukeneyo. Kwizandla ezibonelelekileyo usebenzisa i-state-of-art equipment, umhlaza wesigaba esiphakeme ungagqitywa ngokuchaneka ngakumbi kunokuba oko kufikeleleka nge-12-core core random biopsy. Ukongeza, i-MRI yeprotate ayifumene nokuba khona kweBakala 6 okanye umhlaza ongaphantsi. Ekubeni isifo esingaphantsi kwesifo "siphunywe" nge-prostituted MRI, amadoda amaninzi asindiswa ngumdlavuza ongadingekile.
Kukho amancinci amaziko okucamngela ehlabathini lonke, mhlawumbi ama-50 ukuya ku-100, enza i-prostate imaging ngokuchanekileyo. Izixhobo ezibalulekileyo kwiziphumo ezinokwethenjelwa zi:
- I-State-of-art, i-3-Tesla Multi-Parametric MRI (mpMRI).
- Ochwepheshe be-MRI abaqeqeshwe kakuhle ngendlela yokwenza i-prostate imaging ngokufanelekileyo
- Oogqirha baqeqeshwe ngokucophelela ekuchazeni i-prostate imaging. Ukuqhubela phambili kwi-imagate ye-prostate kwenzeka ngokukhawuleza kangangokuba ezinye ii-radiologists eziqinisekisiweyo zebhodi zisazi ukuba yiyiphi i-teknoloji yakutshanje.
Amadoda anesithombeni se-3T mpMRI asibonisi izilonda ezinokusola zingacinga ukuba i-biopsy iphela kwaye mhlawumbi ilandelwe ngokucinga xa kukho i-PSA iphakamileyo. Xa i-lesion esicokisekileyo ifunyenwe, i-biopsy ejoliswe kuyo isebenzayo kwii-3 okanye ezine ii-cores ingajoliswa ngokukodwa kwizinto ezingavumelekanga.
Ukutolika ingxelo ye-Prostate MRI
Ugqirha ofunda iskripthi isishwankathela ingcamango yakhe yonke yeziphumo, eziwela kwiindidi ezintathu eziphambili:
- Akukho ubungqina beli gulane eliphezulu (ngoko, akukho mfuneko ye-biopsy).
- I-lesion esolwayo ifunyenwe. (I-biopsy ejoliswe kuyo iyimfuneko.) Ukuba izifo eziphezulu zifunyaniswa, ukuqhubeka kwesigxina kulandelwa ukululekwa malunga nenkatho kuyadingeka).
- Indawo ekhohlakeleyo ifunyenwe. (Ingaba i-biopsy ejoliswe kuyo ingacingelwa okanye enye indlela, ukubeka esweni okuqhubekayo kunye nezinye iiskrini ezinyangeni eziyi-6 ukuya kwezi-12 ziyakucingwa).
Ngexesha kwiiLiopsy Ambiguous lesions
Ukucingwa "kubona" zonke iintlobo zezinto ngaphandle komhlaza, kubandakanywa nezicubu ezinqabileyo, indawo yokuvuvukala okusebenzayo (prostatitis), kunye neendawo ezixhamlayo ze- prostatic hypertrophy (BPH). Izilonda zenkxalabo enkulu yilezo zinkulu, ezikwindawo yendawo ye-prostate, i-capsule, okanye ihambelana nokunyuka kwegazi okanye ukusabalalisa. Isilonda esingenangqondo singadinga i-biopsy ukuba iziganeko ezilandelelanayo zokulandelela zibonisa ukwandiswa kokuqhubekayo. Isigqibo malunga nokuba i-biopsy i-lesion engenangqondo ngokukhawuleza okanye iqhubeke nokubeka iliso kunye nokutshekisha kwesikhashana kufuneka yenziwe ngokuxubusha phakathi kwesigulane kunye nodokotela ogqirha oqonda le teknoloji entsha.
Misa i-PSA Screening Yonke?
Ngo-2011, ngenxa yokuxhalabisa ngokugqithiseleyo kwi-PSA yokuhlola kunye ne-biopsy yangokuthi ihamba phambili kwimiphumo emibi yonyango esuka kwimiqathango engeyimfuneko, unyango lwe-US Preventative Services Task Force lunconywa ngokubhekiselele kwenkqubo yokuhlola i-PSA . Uphononongo lubonisa ukuba oogqirha abanqununu abaninzi bathabathele ezi ngcebiso kwiintliziyo kwaye bayeka ukwenza ukuhlolwa. Kodwa i-Task Force ayilahlekanga iphuzu. Ukuqwalaselwa kwe-PSA akuyona ingxaki. Ingxaki iqhubela kwi-biopsy ngokukhawuleza nanini na ukuphakama kwe-PSA kwenzeka. Indlela ejongene nokunyamekela, eyaqala ngokugqithisa iprotected imaging kwaye ilandele i-biopsy ekujoliswe kuyo xa kunokungaqhelekanga kubonakala kungakwazi ukuqeda ingxaki yonyango olungaphezulu.
Iingcamango Zokugqibela
Ihlabathi lezonyango lilungelelanisa ngokukhawuleza ukuba i-12-core core random biopsy ikhokelela ekufunyaniselweni okungafunekiyo, i-Canleers ye-Gleason-grade 6. Unyaka ngamnye eUnited States amadoda angama-100 000 afunyaniswa ukuba nalawa "asemdlalweni" angenakubungozi. Ngelishwa, abaninzi babo bafumana umbane okanye ukuhlinzwa ngokungadingekile. Isinyathelo sokuqala ekunakekeleni ngcono amadoda aphantsi kokuhlolwa kwe-PSA kufuneka kube sisetyenziselwa ngokubanzi ukusasazwa kwemifanekiso yezobugcisa, kunokugxotha ukwenza i-biopsy engahleliyo.
> Imithombo:
> Eggener S, et al. Journal of Urology Vol. 185, P. 869, Matshi 2011.
> Klotz L, et al. Umbhalo we-Clinical Oncology Vol. 28, P. 126, ngoJanuwari 2010.
> Sakr W, et al. Journal of Urology Vol. 150, P. 379, 1993.
> Thompson I, et al. I-New England Journal of Medicine Vol. 349, P. 215, Julayi 2003.
> I-US Preventative Task Force. I-prostate Cancer: Ukuhlolwa. Meyi 2012.
> Wilt T, et al. I-New England Journal of Medicine Vol. 367, P.203, Julayi 2012.